The recognition that health care extends beyond the walls of hospitals and doctor’s offices is growing. In Greensboro, North Carolina, advocacy groups, sociologists and medical practitioners are taking a creative approach to uncovering the root causes of disease, with a particular focus on poor housing conditions that can lead to chronic illness. John Yang reports.

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Judy Woodruff:

Let's take a look now at an innovative approach to health care.

John Yang tells us about an effort in North Carolina that tries to treat the housing conditions that contribute to chronic illnesses like asthma before they become health emergencies.

Krishnaveni Balakrishnan:

You can see mold growth all along the wall here.

John Yang:

There is so much mold in the Greensboro, North Carolina, rental property that inspectors Krishnaveni Balakrishnan And Ken Cook are examining that the residents moved out after only a few weeks.

Krishnaveni Balakrishnan:

There's mold on the children's pillows.

The family that lives here, they have five children. One of them is asthmatic, and the mold in the home is causing not only that child, but also the rest of the family to become sick.

There's a lot of moisture issues, a lot of mold on the ceiling, on the family's belongings. The home is not habitable.

John Yang:

The residents say the landlord's suggestions for getting rid of the mold didn't work. They had to pay for a hotel while still paying rent here.

Krishnaveni Balakrishnan:

You can tell where it's been wiped.

John Yang:

Balakrishnan and Cook don't work for the city. They work for an advocacy group called the Greensboro Housing Coalition. They're part of an innovative approach aimed at improving the health of low-income residents.

Krishnaveni Balakrishnan:

There's some mold in the doorsill.

John Yang:

Doctors, housing advocates and community activists say taking care of houses like this can be a form of preventive medicine. By getting rid of unhealthy environments, they can keep people out of the emergency room.

Researchers say asthma accounts for 93 percent of the respiratory illnesses in Greensboro emergency rooms and clinics. On this day, one of them is Alveno Stanford's 14-year-old son, Jacob.

Alveno Stanford:

And I noticed how his chest would like come out more than usual. So, I could tell the chest was just, like, coming out more.

John Yang:

It's not the first time Jacob's made a costly emergency room visit.

Alveno Stanford:

Three times a year. Like, this year, he may come three. Year before that, he may come like two or three. And it's been at least 10 times with him.

John Yang:

Greensboro's efforts are part of a growing interdisciplinary approach, attacking the causes of conditions like asthma to try to improve health and reduce medical costs.

Stephen Sills is a University of North Carolina-Greensboro sociologist. He looks for patterns in asthma cases using data from the Cone Health system, the city's major hospital operator and a partner in the project.

Then he uses Google Maps Street View to plot substandard housing.

Stephen Sills:

We map that, block by block, neighborhood by neighborhood. Where are more of these respiratory illnesses coming from?

And we see that there's three areas in Greensboro that really are the concentration of poor roofing, absent gutters, broken and cracked foundations, cracked windows, missing shingles and siding.

John Yang:

And they're the same areas where asthma cases are concentrated, underscoring the link between poor housing and poor health.

All these conditions you just described would exacerbate or trigger asthma?

Stephen Sills:

Exactly. Exacerbate is a good word there.

If I'm living in a house where the roof is leaking, the pipes are leaking, there's mold and mildew, the carpet hasn't been replaced in years, all are triggers for someone who has a respiratory condition like asthma.

John Yang:

Sills' students use the data to make referrals to the Greensboro Housing Coalition. It turns the traditional approach to delivering health care on its head.

Stephen Sills:

So often, the physician is thinking about the biology of the individual? What's wrong with this person? How can I treat that problem that is a biological, medical problem? What drug can I give them, or what behavior can I ask them to change?

In this case, the treatment is for the community. The problem isn't the individual. The problem is the structure around the individual.

John Yang:

Sills' research provides hard data to support the coalition's work at an apartment complex in the impoverished east Greensboro neighborhood of Cottage Grove.

Yes, sewage was coming up in the drain. That's why the water is so dark. So, the way they were turning this on and off was by pliers.

John Yang:

And the people are paying rent for this?

Josie Williams:

Yes.

John Yang:

There were 177 apartments, and 100 cases of asthma.

Josie Williams:

We walked into an apartment one day, and the sewage from the bathroom had come out of the toilet onto the floor, into the living room. And the family had been living like that for three weeks.

John Yang:

Three weeks?

Josie Williams:

Mm-hmm.

We walked into another apartment complex where the ceiling was leaking, and it was raining, and the mother was catching the water with an inflatable pool in the middle of the floor.

John Yang:

One of the asthma cases, 7-year-old Shah Mei, whose family immigrated from Myanmar.

Dr. Beth Mulberry is her pediatrician.

Dr. Beth Mulberry:

They were living without heat. It was below 20. They had a huge water problem. Their carpet was soaked. She was needing to be on maintenance medication, allergy medication, oral. And then she was on a rescue inhaler, which she was using fairly regularly at that point.

I think it was about two months. So, it's pretty quick and pretty amazing change. She has not used her rescue inhaler since July.

John Yang:

The complex has since been sold, and the coalition is working with the new owner to improve it.

Led by Josie Williams, the Housing Coalition holds monthly neighborhood meetings to help residents press for other changes in the area. At their most recent session, they discussed a corner store.

Josie Williams:

Anything healthy in that little store? Alcohol, cigarettes? What else you see in that little store? Snacks? What else? You have the power to create those changes.

John Yang:

The recognition that health care extends beyond the walls of hospitals and doctors offices is growing.

In October, federal officials approved a five-year pilot program allowing North Carolina Medicaid to pay for such services as removing mold, controlling pests and repairing heating and air conditioning.

Dr. Beth Mulberry:

We really need to start making an investment in what are the root causes of these chronic illnesses. And a lot of this has to do with our people that are living in poverty, the inability to rent a place where they expect changes to be made if it's an unhealthy environment for them.

Go Deeper

John Yang is a correspondent for the PBS NewsHour. He covered the first year of the Trump administration and is currently reporting on major national issues from Washington, DC, and across the country.